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Usefulness of Ocular Compression During Electroencephalography in Distinguishing BreathHolding Spells and Syncope From Epileptic Seizures

Section of Neurology Department of Pediatrics St. Christopher's Hospital for Children Philadelphia, Pennsylvania, divya.khurana{at}drexel.edu.

Ignacio Valencia, MD

Section of Neurology Department of Pediatrics St. Christopher's Hospital for Children Philadelphia, Pennsylvania

Seshurao Kruthiventi, MD

Section of Neurology Department of Pediatrics St. Christopher's Hospital for Children Philadelphia, Pennsylvania

Edward Gracely, MD

Department of Family, Community and Preventive Medicine Drexel University College of Medicine Philadelphia, Pennsylvania

Joseph J. Melvin, DO

Section of Neurology Department of Pediatrics St. Christopher's Hospital for Children Philadelphia, Pennsylvania

Agustin Legido, MD, PhD

Section of Neurology Department of Pediatrics St. Christopher's Hospital for Children Philadelphia, Pennsylvania

Sanjeev V. Kothare, MD

Section of Neurology Department of Pediatrics St. Christopher's Hospital for Children Philadelphia, Pennsylvania

Episodes of syncope or breath-holding spells are often misdiagnosed as epileptic events. The purpose of this study was to assess the usefulness of an electroencephalogram (EEG) with ocular compression to distinguish breath-holding spells and syncope from epileptic seizures. A retrospective analysis was performed on the EEG records of all children on whom ocular compression was performed from 2000 to 2003. Data from 116 patients with a clinical diagnosis consistent with either syncope or breath-holding spells were compared with a group of 46 patients with epilepsy. The RR interval during ocular compression was significantly higher in syncope patients compared with patients with epilepsy (P < .005). Using 2 seconds of asystole as the cutoff, the sensitivity of ocular compression was 26%, with 100% specificity. The change in RR interval from baseline to ocular compression also distinguished patients with breathholding spells and syncope from patients with epilepsy. Even a small increase of 0.5 seconds in the RR interval demonstrated a sensitivity of 46%, with a specificity of 98%. Ocular compression performed during an EEG is useful in distinguishing patients with breath-holding spells and syncope from those with epileptic seizures. A requirement of a 2-second period of asystole with ocular compression excludes many patients. Our data indicate that an RR interval increase of 0.5 seconds over baseline identifies additional patients with increased vagal tone. Prompt and accurate diagnosis of the etiology of loss of consciousness might preclude the need for further extensive and expensive evaluation and reduce patient and parental distress. (J Child Neurol 2006;21:907—910; DOI 10.2310/7010.2006.00209).

Journal of Child Neurology, Vol. 21, No. 10, 907-910 (2006)
DOI: 10.1177/08830738060210101301


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This article has been cited by other articles:

				D. Khurana, I. Valencia, S. Kruthiventi, E. Gracely, J. Melvin, A. Legido, and S. Kothare Correspondence on "Electroencephalography (EEG) With Ocular Compression in the Diagnosis of Breath-Holding Spells or Syncope" J Child Neurol, June 1, 2008; 23(6): 716 - 717. [PDF]

				J. B. P. Stephenson Clinical Diagnosis of Syncopes (Including So-called Breath-Holding Spells) Without Electroencephalography or Ocular Compression J Child Neurol, April 1, 2007; 22(4): 502 - 508. [Abstract] [PDF]